Dr. Shawel A presented a 20 minute presentation on uterine compression suture. The presentation outlined the objective to understand uterine compression suture effectiveness, materials, techniques and complications. The B-Lynch suture is the most common compression technique, though variations exist. Effectiveness rates vary depending on indications but the technique is generally safe and preserves fertility. Absorbable sutures like chromic catgut are typically used. Complications can include necrosis, erosion and synechiae though future fertility is usually unaffected.

1. 20 minute presentation on
Uterine compression suture
Presenter : Dr. Shawel A (R4)
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2. Outline
• Objective
• Uterine compression suture
• Suture materials
• Other uterine compression suture techniques
• Uterine flexion suture
• Procedure-related complications
• References
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3. Objective
• To understand Uterine compression suture, effectiveness , suture
materials , Other uterine compression suture techniques and
procedure related complications
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4. Uterine compression suture
• Because they give the appearance of suspenders, they are also called
braces
• The B-Lynch suture is the most common technique for uterine
compression
• Several variations of this technique have been described and no
technique has been proven significantly more effective than another
• Generally, longitudinal sutures are easier to place and safer than
transverse sutures, but this may not always be the case
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5. How effective is uterine compression suture ?
• Indications vary for its application, and this will affect the success
rate
• B-Lynch (2005) cited 948 cases with only seven failures
• Conversely, Kayem and associates (2011) described 211 women
who had an overall failure rate of 25%, which did not differ
between B-Lynch sutures and their modifications
• In another series, the failure rate was 20% (Kaya, 2016)
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12. B-Lynch suture
• Envelops and compresses the uterus, similar to the result achieved with
manual uterine compression
• In case reports and small series, it has been highly successful in controlling
uterine bleeding from atony when other methods have failed
• The technique is relatively simple to learn, appears safe, preserves future
reproductive potential, and
• Does not increase the risk of placentation-related adverse outcomes in a
subsequent pregnancy, but may increase chances of developing Asherman
syndrome
• It should only be used in cases of uterine atony
 It will not control hemorrhage from placenta accreta spectrum
 It will not prevent PPH in future pregnancies
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13. SUTURE MATERIAL
• A large Mayo needle with #1 or #2 chromic catgut (or any absorbable
suture if catgut is unavailable) is used
• A large suture is used to prevent breaking, and a rapid absorption is
important to prevent a herniation of bowel through a suture loop
after the uterus has involuted
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• COMOC-MG stitch Notes:
• a 80 mm long straight taper
point needle is inserted into the uterus
from 3 cm below and 3 cm medial to
the lower cut edge of the uterus
• b The loop around the eye of the
needle is cut to obtain two free limbs
posteriorly and two free limbs
anteriorly
• c From double strand, one strand will
make a loop on the top of uterus as
Heyman's suture
• d the second strand with round body
needle will now pass to the avascular
area just below the cut edge of uterus
at the same level on the posterior
aspect and
• e and f both limbs of the second
suture strand tied firmly to occlude the
uterine artery

17. …Cont’d
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19. • Vedio 1
• Vedio 2
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20. Cont’d
Proper patient positioning
• Legs apart, patient flat, or, if stable, in slight reverse Trendelenburg
will enhance the ability to assess the efficacy of these efforts by
allowing for better assessment of persistent vaginal bleeding
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21. ….Cont’d
• The technique has been used
alone and in combination with
balloon tamponade.
• This combination has been
called the “uterine sandwich”
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23. Other uterine compression suture techniques
• Represents modifications of the B-Lynch suture
● Hayman
 Describes placement of two to four vertical compression sutures
from the anterior to posterior uterine wall without hysterotomy
 This is a good choice for surgical treatment of atony after a vaginal
birth
A transverse cervico-isthmic suture can also be placed if needed to
control bleeding from the lower uterine segment
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24. …Cont’d
Pereira
 Described a technique in which a series of transverse and longitudinal
sutures of a delayed absorbable multifilament suture are placed around
the uterus via a series of bites into the subserosal myometrium, without
entering the uterine cavity
 Two or three rows of these sutures are placed in each direction to
completely envelope and compress the uterus
 The longitudinal sutures begin and end tied to the transverse suture
nearest the cervix
 When the transverse sutures are brought through the broad ligament,
care should be taken to avoid damaging blood vessels, ureters, and
fallopian tubes
The myometrium should be manually compressed prior to tying down
the sutures to facilitate maximal compression
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25. ….Cont’d
• Cho
 described a technique using multiple squares/rectangles
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29. Uterine flexion suture technique
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30. Procedure-related complications
• Such as:
 Uterine ischemic necrosis with peritonitis
 Erosion, and
 Pyometra, have been reported rarely
• Limited follow-up of patients suggests that there are no adverse
effects on fertility or future pregnancy outcome
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31. …Cont’d
• Although uterine synechiae have been reported on postpartum
hysteroscopy or hysterosalpingogram
• Some of these patients may have also had curettage, which could
account for the finding
• A few women, however, with B-Lynch or Cho sutures developed
uterine wall defects
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33. References
• Jiang H, Wang L, Liang J. Uterine compression suture is an effective mode
of treatment of postpartum haemorrhage. Pak J Med Sci. 2020;36(2):131-
135. doi: https://doi.org/10.12669/pjms.36.2.1072
• Matsuzaki, S., Jitsumori, M., Hara, T. et al. Systematic review on the needle
and suture types for uterine compression sutures: a literature review. BMC
Surg 19, 196 (2019). https://doi.org/10.1186/s12893-019-0660-z
• Şahin H, Soylu Karapınar O, Şahin EA, Dolapçıoğlu K, Baloğlu A. The
effectiveness of the double B-lynch suture as a modification in the
treatment of intractable postpartum haemorrhage. J Obstet Gynaecol.
2018 Aug;38(6):796-799. doi: 10.1080/01443615.2017.1420046. Epub
2018 Mar 20. PMID: 29557226.
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34. ….Cont’d
• Nalini N, Kumar A, Prasad MK, Singh AV, Sharma S, Singh B, Singh TH,
Kumar P, Singh HV, Singh S. Obstetric and Maternal Outcomes After B-
Lynch Compression Sutures: A Meta-Analysis. Cureus. 2022 Nov
9;14(11):e31306. doi: 10.7759/cureus.31306. PMID: 36514660;
PMCID: PMC9734287.
• Wiliams obstetrics 26th edition ( postpartum hemorrhage , uterine
compression suture )
• GABBE’S OBSTETRICS Normal and Problem Pregnancies 8TH EDITION
• Uptodate 2023
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35. Thankyou
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